Operative hemorrhoidectomy.

A well-performed hemorrhoidectomy is the procedure of choice for fourth-degree prolapsing irreducible hemorrhoids (including thrombosed prolapsed hemorrhoids) and most third-degree hemorrhoids. It eliminates the vascular cushions, produces mucosal fixation, and eliminates the anal stenosis. Although open hemorrhoidectomy is performed in some centers, the majority of colon and rectal surgeons perform closed hemorrhoidectomy by the Ferguson technique, which has been modified by the author and colleagues, with satisfactory results.